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Ten Years Later, What’s Changed?

The events of 9/11 will forever be engrained in our memories. The attacks on the twin towers, Pentagon, and the anthrax attacks which followed were unimaginable at the time. Ten years after these tragic events, what’s changed?

We now know that terrorist threats are ever present and that our nation must be in a constant state of vigilance in order to protect our communities. We’ve come a long way since 2001 in bolstering our nation’s ability to prepare for and respond to catastrophic events whether natural, accidental, or intentional. We are also learning more and more every day that the resources we need for the big disasters are much the same as the ones we use for everyday public health activities.

Check out my list of top 5 accomplishments in the years after the 2001 attacks:

5.A much-needed global perspective that acknowledges that pandemics or terrorist threats don’t stop at geographic borders. A number of programs have been established to rapidly detect and contain emerging health threats, including bioterrorism threats. Programs like CDC’s Global Disease Detection are increasingly focused on building local capacity to support global efforts directed at preparedness and response for disease outbreaks. This means identifying potential outbreaks or threats where they emerge and before they have a chance to spread globally.

4. Improved communication and information sharing. Response efforts following the 9/11 and anthrax attacks lacked the kind of integrated communication and unified command needed for a large scale response. Information critical for decision making was not shared between agencies and there were difficulties keeping local, state, and federal officials informed. Today we have systems such as Epi-X and the Health Alert Network (HAN), which allow health officials to access and share information quickly with other professionals and the public. In addition, public health departments in every state have established relationships and conducted exercises with key emergency management players such as law enforcement, fire departments, and hospitals.

3.Establishment and expansion of federal resources. The 2001 anthrax attacks were a wake up call to the realities of bioterrorism. Scientists in laboratories and doctors in hospitals had to be ready at all times to identify illnesses related to bioterrorism and treat victims of these attacks. This is no small feat as illnesses linked to bioterrorism often mimic the symptoms of more common maladies. Not to mention, once a cause is identified treatment is not always something readily available.

Before 1999, CDC performed all tests to detect and confirm the presence of biological threat agents such as anthrax. This took up valuable time when every second counted. Today, more than 150 laboratories across the nation belong to CDC’s Laboratory Response Network and can test for biological agents, saving both time and money. Additionally, CDC’s Strategic National Stockpile now ensures the availability of key medical supplies and all states have plans to receive, distribute, and dispense these assets. To help prevent improper use of select agents and toxins (e.g., anthrax, Ebola virus, botulinum), CDC’s Division of Select Agents and Toxins helps provide oversight by licensing, registering, and identifying entities working with these agents.

2.Federal funding for states and localities to build and strengthen their ability to prevent and respond to disasters. The events of 2001 revealed our vulnerability to the use of weapons of mass destruction and made public health a new participant in the national security discussion. Significant investments were made in state and local preparedness and response infrastructure, planning, and capability development for “routine” outbreaks and in the face of large scale disasters and epidemics. Today CDC provides funding to all 50 states, 4 metropolitan areas, and 8 territories. Grantees use this money to support laboratories, outbreak investigations, and risk communication among other things.

1. Following the 2001 attacks there was a cultural shift in how we think about national security. It had become apparent that public health played an important role in national security. The terrorist attacks changed the way state and city health departments worked and interacted with other agencies and sectors. Health departments are increasingly becoming accepted as equal partners by traditional first responders, including law enforcement, fire departments and emergency medical services. These interactions are supported by the incorporation of public health components into the National Response Framework and Nation Incident Management System (the “playbooks” federal, state, and local responders use to plan for and respond to emergencies). Our ability to respond to disasters is strengthened with each area of government working together.

Looking Ahead

Progress made in preparedness over the last decade has benefitted routine and surge responses, saving lives and preventing illness and injuries. There is growing recognition that preparedness and core (“routine”) public health investments are synergistic. Large scale and unpredictable disasters and disease outbreaks require many of the same routine surveillance, laboratory, risk communication, and other core public health capabilities and systems. Although we are better prepared today we continue to face new challenges with fewer resources. Looking ahead we must increase our focus on communities and better define and enhance community and local resilience. We also need to enhance our focus on vulnerable population that require additional assistance during emergencies and finally, improve the evidence base for preparedness activities to show that work before a disaster really does pay off.

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